Medical workers continue to fight the Corona pandemic relentlessly. The psychological and mental health of the nursing staff has been greatly affected. We speak with Sakura Wimalasuriya, a professional nurse practitioner who provides psychological assistance to nurses, regarding her background and the nursing environment in general.
Less than a year following graduating from nursing school and joining the critical care department, Sakura Wimalasuriya—who works under the recognizable name Wime Sakura in Japan—has lost her smile. She remembers how these rumors made her realize that she was not feeling well emotionally.
“I mightn’t sleep or eat. When I got up in the morning, I mightn’t stop crying. However, I thought if I tried harder, I would be able to overcome what was happening to me.” A doctor in the hospital from the psychiatry department learned regarding Wim’s mental disorders, and he diagnosed her as suffering from depression. Although she dedicated her life to helping others through her work as a nurse, for the first time in her life she was overcome with frustration and defeat.
The desire to save lives
Wim was born in Nagoya to Sri Lankan parents, and spent her early childhood in Sri Lanka and Britain. But she has been living in Japan since elementary school.
“At school, I knew that being Sri Lankan made me different. I am starting to feel connected to Sri Lanka and other developing countries. My parents told me that Japan is a safe and prosperous country, where people live in peace and have a high level of education. From an early age, I had a strong feeling, that I was lucky enough to live here, that I should take advantage of being in such a privileged environment and use what I learned to help others.”
However, Sakura admits that she was an introverted child. “I didn’t like my name because I didn’t understand how it was called Sakura and I didn’t look and sound Japanese like I used to. Despite that, I tried hard to act like a Japanese.”
She attended the massive high-prep high school, where she was surrounded by a diverse group of students, including many of foreign descent like herself, which made her feel liberated, and she immersed herself in extracurricular activities and the Student Council, which in turn translated into a very active school life. “I realized that I was lucky because my name was Sakura: because it is a name that people remember easily,” she continues.
Wim started thinking regarding her future during middle school. She remembers being deeply moved by a documentary regarding a Japanese midwife who went to Africa as part of the Doctors Without Borders group. She realized she wanted to dedicate her life to a healthcare career, which she hoped would be able to save lives. Wim was in primary school when the 2004 Indian Ocean earthquake struck, but she has vivid memories of the tsunami that devastated the coast of Sri Lanka, killing members of her father’s family.
Self-blame for patients’ deaths
After graduating from high school, Wim enrolled in the School of Nursing. “The Great East Japan Earthquake of 2011 happened while I was taking my high school entrance exams, and the 2016 Kumamoto earthquake coincided with my national certification exams in nursing,” says Wim. I was not able to join the volunteer activities to directly help the victims affected by the disaster, so I felt a strong desire to dedicate my life to work in emergency and critical care.”
When Wim started working, she fulfilled her dream of working in the emergency department.
“The emergency surgery ward also receives patients who have been transported by ambulances and need emergency surgery. It was a race once morest time and there is no room for talking. In other departments, if a junior nurse fails, it is covered by a more experienced nurse and there is no risk to patients. But in the emergency ward, I felt constant stress, because mistakes caused by my lack of knowledge or skills might endanger patients’ lives.”
Wim remembers that, just two weeks following the start of her work, there was a patient who was taking care of her and dealing with her cases in her first week. Her health conditions suddenly worsened and she died. “Although I lost my relatives in the disaster in Sri Lanka, I did not see death so close to me. The fact that I was on the front lines as a nurse was a real trauma and caused me to end up traumatized.”
From that moment on, Sakura started blaming herself every time a patient died.
“When a patient’s health rapidly deteriorates before your eyes, there is not much you can do. Objectively speaking, a junior nurse’s capabilities are limited. However, I was getting restless, thinking things might be different if I had more knowledge and experience or if I acted a little faster. When I got home I mightn’t stop thinking regarding work and had trouble sleeping at night. I suffered from constant anxiety.”
We can change the way we think
Why did her psychological conditions worsen? “I quit work because of depression and following recovering for some time I started looking for the reasons. She signed up for an online college course in psychology. “It was then that I realized that my beliefs regarding what a nurse should be were very, very rigid.”
“I wasn’t the problem per se, but my way of thinking,” she recalls. But we can change the way we think. I had previously been able to change my negative view of things into a positive one when I entered middle school. When I studied cognitive behavioral therapy, I saw that I might take care of my mental health by correcting bad mental habits, which made me feel good.”
In one year, Wim qualified to be a certified clinical psychologist. She also had the opportunity to study traditional Ayurvedic treatment in Sri Lanka.
“Ayurveda is one of the three main traditional medicinal systems recognized by the World Health Organization,” says Wim. It originated in India and spread to Sri Lanka. Ayurveda values the importance of self and family and also aims to prevent not only physical ailments, but also mental ailments at an early stage. This way of thinking is associated with the philosophy of life widely found in Sri Lanka. Through these ideas, you learn how to take care of your mental health.”
“At the same time, I was concerned regarding the low awareness of psychological and mental health in Japan, despite the technological advances in the medical field.”
Mechanisms to ensure the mental health of nurses
“After learning how to take care of my mental health, I rejoined the workforce. But in the Tokyo hospital where I worked, I saw many colleagues and bosses leave because of depression. I knew that there must be many nurses in Japan with similar problems, and I felt the need to do something.”
However, she points out, Japanese hospitals are hierarchical institutions, where people are evaluated in line with their superiors. This is often what causes them to resist new ideas. It is difficult to change anything from within the system. I felt we needed to create an external structure that is open to new ideas and lasts for the long term if we hope to help more people. This led to my interest in social work.”
Wim joined the Entrepreneur Development and Promotion Program run by Japan’s Ministry of Economy, Trade and Industry, hoping to create psychological support systems for nurses.
“The program is designed to develop mindsets and skills to stimulate innovation. They also created a network of 100 people. There were people from different sectors, and they had a strong vision and enthusiasm. When I had doubts, they suggested study sessions and helped me. Many were deeply sympathetic to the issue of nurses’ mental health. With the encouragement of my colleagues, I was able to take the first steps towards establishing my business.”
Imagine the feelings!
Wim launched Plus Buzz in February 2021 with the aim of creating mechanisms to provide psychological support to workers.
“Nurses in particular focus mainly on caring for patients, and tend to neglect their mental health. My company offers medical institutions an online app with mental state visualization testing tools for users, can recommend self-care tailored to individual circumstances and mindfulness tools, and has e-learning materials optimized for nurses.”
To date, 90 nurses in the field have collaborated to test the effectiveness and ease of use of tools and materials being developed.
“When they use our tools, we can check if they are really helping to solve problems for nurses, and we can continue to make improvements. In the spring of 2022, the program will start as a trial in medical institutions.”
Wim and her team have raised funding from venture capitalists and investors to develop their own web services and launch the program as a pilot in medical and research institutions. She now leads a group of employees her age, including an online social media manager, editor, and online marketer. She herself works a few days a week as a nurse in a dedicated psychosomatic medicine clinic in Tokyo.
“We can approach things from a range of perspectives because each of us is still working in our area of expertise. I think this style of work, which is more regarding skills than job titles, is appropriate for this day and age, when the focus is on using people’s unique traits and skills.”
The importance of teamwork
Many nurses have joined the profession with the same strong desires that drove Wim: to save lives and serve others. But their dedication to work is not properly valued or recognized, which leads many nurses to burnout and quit.
“Nurses perform many tasks under the supervision of doctors, such as administering drips and intravenous medications. But there are also many tasks that are difficult to define. Nurses attend to patients’ endless requests: fetch things, massage their backs, help them when they can’t sleep, and try to lift patients’ spirits. It is difficult to evaluate these small daily tasks. On the other hand, they perform these tasks in a work environment where lives are on the line “life or death”, and there is a strong focus on lapses and they are not tolerated: thus there is a tendency to focus only on mistakes.
Despite this, Wim says teamwork is essential. “Some nurses told me, no matter how hard they work, you can do your best if you have a good team. I want to create a culture where they receive positive feedback – one that encourages not to repeat mistakes, and public praise for their strengths.”
“No matter how close nurses are to their patients, it is difficult to assess their performance and this is reflected in their salaries. That is why it is important that they support each other. On the other hand, when a nurse is tired or mentally ill, it is difficult to communicate with colleagues. So taking care of themselves is beneficial for the team and the patients. I hope to do everything I can to help nurses take better care of themselves.”
(Originally written in Japanese by Kimi Itakura of Nippon.com. All images courtesy of Nippon.com.)
